Provider Demographics
NPI:1740598234
Name:GREGORY L. TOTEL, M.D.,S.C.
Entity Type:Organization
Organization Name:GREGORY L. TOTEL, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TOTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-875-1090
Mailing Address - Street 1:1 MEMORIAL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6317
Mailing Address - Country:US
Mailing Address - Phone:217-875-1090
Mailing Address - Fax:217-875-1099
Practice Address - Street 1:1 MEMORIAL DR STE 201
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6317
Practice Address - Country:US
Practice Address - Phone:217-875-1090
Practice Address - Fax:217-875-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05822058OtherBLUE CROSS BLUE SHEILD
IL036068474Medicaid
ILC49000Medicare UPIN
IL203170Medicare PIN